being driven more by cost containment pressures than by empirical evaluation to ensure their effectiveness in matching patient needs with available resources. With one exception (Neely, 1998), very few such evaluations have been published thus far.

Managed care has extensively penetrated rehabilitation services in some major cities and is growing rapidly elsewhere (DeJong et al., 1996). There is a paucity of research on the impact of managed care on rehabilitation services. So many questions remain unanswered that a blueprint for research on managed care and people with disabilities has been developed (U.S. DHHS, 1995; IOM, 1997a). Although 70 percent of working Americans are enrolled in managed care, the need to demonstrate the relationship between quality of trauma care and rehabilitation and costs and outcomes is important for all Americans. This information is needed for defining best practices and for shaping treatment guidelines. It is also essential to the development of innovative service delivery models that benefit the patient while attending to the escalating costs of health care.

The committee recommends intensified trauma outcomes research, including research on the delivery and financing of acute care services and rehabilitation. The committee envisions that HRSA and other appropriate federal agencies (e.g., NCIPC, AHCPR) will collaborate on this research.

Specific areas of research that should be addressed include the following:

  • the cost-effectiveness of specific clinical and service interventions to establish best practices in trauma care;

  • the most efficient and effective strategies for organizing and financing the delivery of both acute care services and rehabilitation, including the impact of managed care arrangements on access to services, quality of care, and outcomes; and

  • the development of improved methods for measuring the severity of injury, particularly for those at high risk of adverse outcomes.

Finally, managed care accrediting organizations should support the development, coordination, and implementation of trauma care systems. They should mandate, as a condition of facility accreditation, participation in an inclusive trauma care system in states and regions with such systems and should promote the development of trauma care systems in states and regions without them.


Great strides have been made over the past decades in developing trauma systems covering a continuum of prehospital, acute care, and rehabilitation

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